EP27.02: Ultrasound‐based clinical history of ovarian endometrioma treated by medical therapy: a 10‐year follow‐up study

To observe the clinical history of fertile women with symptomatic ovarian endometrioma diagnosed by 3D-transvaginal sonography (3D-TVS) and treated by medical hormone therapy (HT). Consecutive fertile women with recto-sigmoid DIE were prospectively enrolled for a longitudinal observational study during 01.01.2006 – 30.12.2015. All patients underwent detailed clinical interview, clinical examination and 3D-TVS examination. 3D-TVS was performed with the GE Voluson 730 and E8 units, using a wide-band 3–9 MHz transducer, with post-processing multiplanar display and VCI analysis by 2 mm slices. HT was proposed as first option in patients referring pain, and consisted of quarterly continuous oral contraceptives (COC) or vaginal ring or progestins, or long-term LNG-IUS. Surgery was proposed in patients referring persistent symptoms resistant to HT. Demographic, medical, imaging and surgical data were recorded. 59 patients with 85 endometriomas were recruited. Mean age was 35 years (SD ±8). Mean BMI was 22 kg/m2 (SD± 3). 33 (55%) patients were nulligravid. 10 patients resistant to HT underwent laparoscopic cystectomy with pathologic diagnosis of endometrioma confirmed in all cases. The median follow-up period of the 49 patients successfully treated by HT was 43 months (IR 25–62). Median mean diameter and median volume of the endometriomas at time-0 (T0) and at median follow-up (T43) were significantly different (27 mm (IR 19–35) and 9.7 cm3 (IR 3.3-20.5) vs 15 mm (IR 0–26) and 1.7 cm3 (IR 0–8.4), respectively). Similarly, mean 10 cm-VAS dysmenorrhea and dyspareunia at T0 and at T43 were significantly different (7 cm (IR 5–9) and 3 cm (0–6) vs 0 cm (IR 0–5) and 0 cm (0–2), respectively). 3D-TVS adequately diagnoses ovarian endometrioma. Medical treatment based on HT should be the first option for an effective and efficient long-term conservative management of patients with symptomatic endometriomas.